Placement Of Self-expanding Plastic Stents Research Articles

Self-expanding plastic stent for esophageal leaks and fistulae.

Self-expanding plastic stents (SEPS) have emerged as a good alternative to surgery in esophageal leaks and fistulae. There is scarce published literature regarding its efficacy in these conditions. We present our experience with SEPS in treatment of esophageal leaks and fistulae. Consecutive patients admitted in a tertiary referral center who underwent SEPS placement for esophageal leak or fistula between February 2012 and February 2015 were retrospectively evaluated. Patients underwent prior assessment with upper gastrointestinal endoscopic and thoracic contrast-enhanced computed tomography assessment. SEPS (25-mm flares, 21-mm diameter) were placed under fluoroscopic guidance. A silk thread tied to upper end was routed through nostril and fixed to prevent stent migration. Nasojejunal tube was inserted in all patients. Intercostal drain was inserted in the case of hydro/pyopneumothorax. Twelve patients [eight male, median age 45.3years (19 to 65years)] were included. Etiologies were spontaneous leaks due to Boerhaave syndrome (n=2), corrosive fistulae (n=2), tubercular fistulae (n=4), invasive Candida esophagitis-induced fistula (n=1), iatrogenic leaks (n=2; one achalasia dilatation, one obesity surgery), and pancreaticoesophageal fistula due to ruptured pancreatic pseudocyst (n=1). Stent placement was successful in all patients with no immediate postprocedure complications. Successful healing was seen in nine patients (75%). Stents were removed after a median time of 83.5days (13-190days). Stent migration was seen in four patients (33.3%), and in two of them, it was retrieved and redeployed; none had early migration (<72h). Reasons for SEPS failure in our cohort were failure of effective sepsis control in two patients and poor wound healing seen in one patient having multiple tubercular fistulae. SEPS is a safe, well-tolerated treatment with good success rate (75%) in treatment of esophageal leaks and fistulae.

Evaluation of Quality of Life Following Placement of Self-Expanding Plastic Stents as a Bridge to Surgery in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer

To determine whether self-expanding plastic stent (SEPS) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy (NAT) in patients with esophageal cancer. A prospective, dual-institution, single-arm, phase II (http://ClinicalTrials.gov: NCT00727376) evaluation of esophageal cancer patients undergoing NAT prior to resection. All patients had a self-expanding polymer stent placed prior to NAT. The European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25, Functional Assessment of Cancer Therapy-Anorexia, and Functional Assessment of Cancer Therapy-General surveys were administered prior to stenting, within 1 week post-stent placement, and at the completion of neoadjuvant therapy. Fifty-two patients were enrolled; 3 (5.8%) had stent migrations requiring replacement. There were no instances of esophageal erosion or perforation. All patients received some form of neoadjuvant therapy. Thirty-six (69%) received chemoradiation; 34 (93%) of these patients received the planned dose of chemotherapy, and 27 (75%) received the full planned dose of radiotherapy. There were 16 (31%) patients receiving chemotherapy alone; 12 (74%) of patients in the chemotherapy-alone group completed the planned dose of therapy. Placement of SEPS appears to provide significant improvement in quality of life related to dysphagia and eating restriction in patients with esophageal cancer undergoing neoadjuvant therapy. Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support.

Stent Type Used Does Not Impact Complication Rate or Placement Time but Can Decrease Treatment Cost for Benign and Malignant Esophageal Lesions

Purpose: Esophageal obstruction occurs from either intrinsic or extrinsic etiologies. Intrinsic causes are more common and largely due to malignancy. The majority of esophageal cancer patients are not resection candidates, requiring palliative stent placement. SEMS (self-expanding metal stents) are thought to be preferable to SEPS (self-expanding plastic stents) for palliation of malignant disease due to perceived decreased technical difficulties and stent migration rates. Data using SEPS in benign disease are mixed and report success rates between 17-95%. In addition, SEPS are not routinely recommended due to complications. The aim of the study was to retrospectively compare safety, efficacy, clinical outcomes and placement ease of SEMS and SEPS in benign or malignant esophageal stenosis. Methods: All patients at UFCOM-Jacksonville endoscopy laboratory having EGD with stent placement for benign or malignant esophageal stenosis between January 2005 and April 2012 were eligible for study. Patients without stent placement at the completion of EGD were excluded. Data collected included patient demographics, procedure time, stent cost and clinical outcomes (technical success of stent placement, procedure-related complications, need for subsequent re-intervention, length of hospital stay and mortality). Results: Forty-three patients underwent stent placement for either benign or malignant disease during the study period. SEMS were placed in 30 patients (25 male, mean age 59.6 yrs old) and SEPS were used in 13 patients (10 male, mean age 61.7 yrs old). Placement outcome of SEPS compared to SEMS did not differ statistically. Complication rate in the SEPS group was 23.1% compared with 25.2% in the SEMS group. Stent migration was the most frequent complication, occurring in 66.7% in the SEPS group compared with 57.1% in the SEMS group. In-hospital mortality was also similar: 7.7% (SEPS) compared with 6.7% (SEMS). Procedure time, need for re-intervention, survival after procedure, length of hospital stay and time to first complication were also not significantly different between SEPS and SEMS groups. Interestingly, metal stents were more expensive than plastic stents with an institution cost difference of approximately $205/stent and even higher patient costs. Conclusion: SEPS and SEMS placement produced similar outcomes for either benign or malignant esophageal occlusion. SEPS are less costly than SEMS and it may be more practical to initially use SEPS due to this factor. If all patients who received SEMS had SEPS placed instead, a significant cost reduction would be realized for this patient cohort.

Alternative management of anastomotic colorectal strictures: our experience with fully covered self-expanding metal stents

We read with great interest the article on endoscopic treatment of postsurgical anastomotic colorectal strictures using biodegradable (BD) stents by Repici et al. [1] published recently in Surgical Endoscopy. In this original article, the authors used nondedicated esophageal BD stents with the intent to treat postsurgical anastomotic colorectal strictures refractory to classic mechanical or pneumatic dilation. Their results showed an overall success rate of 45 % (5 of 11 patients) and a 36 % rate (4 of 11 patients) of stent migration. The unique feature of the BD stent is the gradual expansion process with less traumatic mucosal injury. This should reduce major adverse events (i.e., bleeding and perforations) compared with self-expanding plastic stents (SEPS) or self-expanding metal stents (SEMS), as we already know [2–4]. Another advantage of the BD stent is the possibility of avoiding a second endoscopic procedure to remove the stent, as usually required after SEPS or SEMS placement. We briefly report our experience with an endoscopic approach to benign colon obstruction at our tertiary referral center of the New Civil Hospital in Modena. Between January 2008 and December 2010, we retrospectively reviewed 17 cases of benign colon obstruction due to an inflammatory or postsurgical stricture, which was treated with fully covered self-expanding metal stents (FCSEMS; Taewoong Medical Co., Seoul, South Korea). Of the 17 patients, 10 had postsurgical anastomotic colorectal strictures. In this subgroup of patients refractory to standard endoscopic dilation, FCSEMS was positioned. After a median long-term follow-up period of 30 months (range 2–40 months), stent treatment definitively resolved the stenosis in 8 (80 %) of 10 patients, with two cases of a minor complication. Late stent migration occurred in two cases (patients 1 and 4), as shown in Table 1. Patient 1 needed early new stent deployment due to subocclusion symptoms. Patient 4 did not request a new stent positioning because a follow-up colonoscopy after 6 months showed an asymptomatic recurrence of the anastomotic stricture, which was treated with a single session of an endoscopic pneumatic balloon (CRE Boston Scientific Corporation, Natick, MA, USA) with a diameter of 18 to 20 mm (4–6 atm). Patient 10 experienced a postsurgical ischemic colitis with a perianastomotic stricture 8 cm long. In this patient, an asymptomatic recurrence of stenosis was registered after 45 days of follow-up evaluation. Therefore, based on the length of the stricture, surgery was scheduled as definitive treatment. Perforation reported in other studies [2–4] could have been related to the decubitus of uncovered meshes of partially covered/uncovered stents embedded in the colon wall thickness. In such cases, perforation could be avoided by adopting FCSEMS or BD stents. Nevertheless, the small diameter and the progressive loss in radial force of the BD stent could drastically reduce the overall success rate in this setting. Thus, dedicated BD colon stents are expected to overcome the high migration rate and to improve clinical outcome. The data from the few series of colonic stenting are conflicting and limited to case series with a limited number of patients or individual case reports. According to our experience and the few published series, we suggest that colon anastomotic strictures shorter than 8 cm should be treated using a FCSEMS with a medium to large diameter A. Caruso (&) M. Manno R. Manta H. Bertani V. G. Mirante R. Conigliaro Gastroenterology and Endoscopy Unit, Nuovo Ospedale S. Agostino Estense di Baggiovara, Modena, Italy e-mail: angelocaruso@hotmail.it

Tracheobronchial Polyflex stents for the management of benign refractory hypopharyngeal strictures

To describe a modified technique for placement of a tracheobronchial self-expanding plastic stent (SEPS) in patients with benign refractory hypopharyngeal strictures in order to improve dysphagia and allow stricture remodeling. A case series of four consecutive patients with complex hypopharyngeal strictures after combined therapy for laryngeal cancer, previously submitted to multiple sessions of dilation without lasting improvement, is presented. All patients underwent placement of a small diameter and unflared tracheobronchial SEPS. Main outcome measurements were improvement of dysphagia and avoiding of repeated dilation. The modified introducer system allowed an easy and technically successful deployment of the tracheobronchial Polyflex stent through the stricture. All four patients developed complications related to stent placement. Two patients had stent migration (one proximal and one distal), two patients developed phanryngocutaneous fistulas and all patients with stents in situ for more than 8 wk had hyperplastic tissue growth at the upper end of the stent. Stricture recurrence was observed at 4 wk follow-up after stent removal in all patients. Although technically feasible, placement of a tracheobronchial SEPS is associated with a high risk of complications. Small diameter stents must be kept in place for longer than 3 mo to allow adequate time for stricture remodeling.

A Comparison of Temporary Self-Expanding Plastic and Biodegradable Stents for Refractory Benign Esophageal Strictures

It is a challenge to manage refractory benign esophageal strictures (RBES). We compared the efficacy and safety of self-expanding plastic stents (SEPSs) with placement of biodegradable stents for the treatment of RBES. We studied 2 groups of consecutive patients with RBES who received temporary placement (6 weeks) of SEPSs (n = 20) or biodegradable stents (n = 18). Data were collected with respect to clinical outcome, complications, recurrent dysphagia, and reinterventions. SEPSs were removed in 16 (80%) patients. Stent placement was not successful in 1 patient, while stent removal was not performed in another 3 patients. Six (30%) patients with an SEPS were dysphagia-free after a median follow-up of 385 days (range, 77-924 days). Ten (50%) developed recurrent dysphagia. Major complications occurred in 2 patients (10%; 1 with hemorrhage and 1 with perforation). Six patients (33%) with a biodegradable stent were dysphagia-free after a median follow-up of 166 days (range 21-559 days) (P = .83 compared with SEPS). Twelve patients (67%) had recurrent dysphagia. Major complications occurred in 4 patients (22%; 2 with hemorrhage, 2 with severe retrosternal pain) with a biodegradable stent (P = .30 compared with SEPS). Reinterventions were less frequently indicated after biodegradeble stent than after SEPS placement (15 [mean, 0.8 ± 0.6 per stent placed] vs 21 [mean, 1.3 ± 0.4 per stent placed], respectively; P = .03). Placement of SEPSs or biodegradable stents provides long-term relief of dysphagia in 30% and 33%, respectively, of patients with RBES. Biodegradable stents require fewer procedures than SEPSs, offering an advantage. Although stent placement is a viable strategy in patients with RBES, the ideal strategy still needs to be defined.

Clinical Outcomes After Self-Expanding Plastic Stent Placement for Refractory Benign Esophageal Strictures

Refractory benign esophageal strictures (RBES) are defined as those that persist structurally and symptomatically after repeated dilation sessions. Small series have reported favorable outcomes after placement and subsequent removal of Polyflex self-expanding plastic stents (SEPS). To characterize the outcomes after Polyflex stent placement in patients with RBES. Outcomes of consecutive patients who underwent Polyflex stent placement for RBES between April 15, 2005 and November 20, 2006 were analyzed retrospectively. The etiology of the stricture, number of dilations prior to initial SEPS placement, size of stent placed, stricture resolution after SEPS removal, cases of stent migration, duration of SEPS placement, time to repeat dilation and/or SEPS replacement after stent removal, and complications were assessed. Twenty-three Polyflex stents were placed in 13 patients suitable for analysis. The majority of stenoses (11/13) were attributable to anastomotic strictures after curative esophagogastrectomy for esophageal neoplasms. All 11 patients in this group had satisfactory relief of dysphagia to solids determined clinically with indwelling SEPS placement. SEPS migration occurred in seven instances (30% of SEPS placed). Dysphagia remediation after subsequent SEPS removal was observed in only three patients (23%). Placement of a partially covered metal stent within a Polyflex stent was necessary in one case due to epithelial hyperplasia. The mean time for repeat dilation and/or SEPS reinsertion due to recurrent dysphagia after stent removal was 37 days (range 6-120 days). Polyflex stents provided satisfactory palliation of dysphagia for RBES while in place. However, unplanned SEPS migration and dysphagia recurrence after stent removal were common.

Temporary Placement of Self-Expanding Oesophageal Stents as Bridging for Neo-Adjuvant Therapy

Placement of self-expanding stents is an effective palliation for dysphagia in non-resectable oesophageal or proximal gastric cancer. The aim of this analysis was to assess the efficacy of temporary stent placement for dysphagia relief during neo-adjuvant treatment for locally advanced disease. A total of 38 patients scheduled for neo-adjuvant chemo(radio)therapy for locally advanced oesophageal cancer (n = 29), cardia cancer (n = 8) or subcardial gastric cancer (n = 1) underwent placement of self-expanding plastic stents (n = 13) or covered metal stents (n = 25) due to severe dysphagia and weight loss. Instant dysphagia relief was achieved in 37 (97.4%) of 38 patients. Dysphagia scores declined from mean 3.0 +/- 0.7 before stent placement to 0.6 +/- 0.9 at restaging. After completion of the neo-adjuvant therapy 20 (52.6%) of the 38 patients underwent resection of the tumour, 5 patients (13.2%) underwent primary resection without receiving chemotherapy while 12 patients (31.6%) did not undergo surgery. Stent-related complications were observed as perforation (n = 1), mediastinitis (n = 1), tracheo-oesophageal fistula (n = 2), bleeding (n = 1) and jejunal perforation caused by a migrated stent (n = 1). Serum albumin significantly decreased in patients with progressive disease despite successful stenting (40.0 +/- 4.9 mg/dl versus 29.7 +/- 6.4 mg/dl, p < 0.05) while stable albumin levels were found in patients who underwent surgery (39.9 +/- 4.3 mg/dl versus 39.1 +/- 3.8 mg/dl, p = 0.484). Placement of self-expanding stents is highly effective for instant dysphagia relief, enabling adequate oral nutrition during neo-adjuvant therapy, but is limited by a high re-intervention rate.

Long Term Placement of Self-expanding Plastic Stents is Safe for Benign Esophageal Disease

Purpose: Removable self-expanding plastic stents (SEPS) are used for the short-term treatment of benign esophageal diseases including strictures and esophageal fistulae. The purpose of this study was to determine the efficacy and safety of SEPS left in place for greater than 90 days for benign esophageal disease. Methods: Patients receiving a SEPS from 2003-2009 for benign esophageal disease at a single university center were retrospectively identified using an endoscopic database (Provation Medical, Minneapolis, MN). Patients with a stent left in place for more than 90 days were included in this study. Indication for stent placement, stent size, duration of stent placement, follow-up endoscopy and imaging studies, and the efficacy of treatment were collected. Results: Nine patients were included. Indication for stent was benign stricture refractory to dilation (8) or esophageal fistula (1). Cause of the stricture was esophagectomy (7), esophageal Castleman's disease (1). Median age was 53.4 years; 8 were males. SEPS placement was successful in all patients. The median stricture length was 2 cm (range 1-8 cm). Stents were left in place for 3-34 months (median 11). In 7, the stent was removed without difficulty. Six received a second stent for stricture recurrence. The most commonly used stent had a diameter of 18mm. Follow-up EGD was performed in eight patients. One patient had stent placement confirmed after 23 months by a CT scan. Stent migration occurred in 3 patients. The most common endoscopic finding was granulation tissue adjacent to the proximal or distal stent margin. One stent migrated proximally into the proximal esophagus, causing ulceration and stricture requiring dilation. In another patient with proximal stent placement for 27 months, a trachea-esophageal fistula developed after stent removal, requiring placement of a new stent and jejunostomy tube. Conclusion: SEPS can be safely left in place for greater than 3 months in some patients with benign esophageal disease refractory to other treatments. Complications developed in those with proximal esophageal placement. Stent migration was seen in 3/9 (33.3%) of patients.Table

Self-expanding plastic stents for inoperable malignant strictures of the cervical esophagus

Dysphagia and respiratory complications are the major problems in patients suffering from malignant strictures of the cervical esophagus. In inoperable cases, interventional palliation is the cornerstone of treatment. The aim of this study was to evaluate the use of self-expanding plastic stents (SEPS) in this group of patients. In a retrospective study, 23 patients suffering from various malignant obstructive diseases of the cervical esophagus, including squamous cell carcinoma (n = 10), laryngeal cancer (n = 7), lung cancer with esophageal invasion (n = 5), and metastatic breast cancer (n = 1), underwent SEPS placement, under endoscopic and fluoroscopic guidance. Tracheoesophageal fistula was documented in five patients. Technical success rate, improvement of dysphagia grade, and stent-related complications were evaluated after stent placement. Stent insertion was successfully achieved in all cases, namely in 20 patients at the first stent placement attempt and in three patients after a second attempt. Dysphagia grade was notably improved after 24 h. In two cases, major complications occurred. These were successfully treated without the need of stent extraction. Barium swallowing studies demonstrated complete sealing of all fistulas. Foreign-body sensation that gradually disappeared within the first week after stent placement was observed in eight patients. Recurrence of dysphagia occurred in three patients, due to hyperplastic tissue proliferation (n = 2) and tumor overgrowth (n = 1). Late migration of the stent was detected in one case after 67 days. SEPS placement is an effective and safe palliative treatment for malignant strictures of the cervical esophagus. Main advantages include easy retrievability and reduced rates of reinterventions.

Self-expanding plastic stents in treatment of benign esophageal conditions

Recently, self-expanding plastic stents (SEPSs) have been proposed for the treatment of benign esophageal disease. Our purpose was to review our experience with SEPSs in patients with benign esophageal conditions. This was a retrospective case review of patients who underwent SEPS placement for benign esophageal disease, including (1) benign stricture, including reflux disease, ischemia, and idiopathic, (2) radiation-induced strictures, (3) anastomotic strictures, and (4) esophageal leak/fistulae. Nineteen male and 11 female patients (average age 52.1 years, range 11-87 years) underwent SEPS placement. SEPS placement. Initial complications, stent migration, long-term complications, and treatment success according to clinical symptoms, follow-up endoscopy, or imaging. Eighty-three of 84 SEPS placements were successful. The most common complications were chest pain, dysphagia, nausea, and vomiting. No deaths were reported from stent placement. Stent migration was more frequent in proximal (30/44 stents, 68.1%) and distal (19/27 stents, 70.4%) compared with mid esophageal (3/10 stents, 30%). Migration was more frequent in stents placed for benign strictures (18/22 stents, 81.8%), anastomotic strictures (18/24 stents, 75%), and fistulae/leak (13/22 stents, 59.1%) compared with radiation-induced strictures (4/14 stents, 28.6%). Only 5 of 83 interventions (6%) resulted in long-term improvement after stent removal. This was a retrospective review, and patients were selected from a tertiary medical center. Use of SEPSs for benign esophageal conditions resulted in frequent stent migration and few cases of long-term improvement. Further investigation is warranted to identify optimal patient populations and to guide future recommendations for the use of SEPSs.

Self-expanding Polyflex plastic stents in esophageal disease: various indications, complications, and outcomes

Esophageal stenting has become an important technique in the treatment of different clinical problems such as malignant or benign stenosis, anastomotic leaks after surgery, or fistulas. In this study we present our experience with the self-expanding Polyflex plastic stent in various indications, arising complications, and patient's outcomes. Over a three-year period, 35 patients underwent self-expanding Polyflex plastic stent placement for esophageal stenosis (n = 23) with 22 malignant, and for perforations, fistulas, or anastomotic leaks after surgery (n = 12). The short-term efficacy and long-term outcomes were analyzed. In patients with stenosis, implantation was performed without any complications in 91% (21/23). In one patient perforation occurred while passing the stenosis; in another patient the stent dislocated during the insertion procedure. Dysphagia score improved from 3.0 to 1.0 after stenting. In all patients with perforations, fistulas, or anastomotic leaks (n = 12), stents were placed successfully without any complication. Complete sealing of the mucosal defect was proven by radiography in 92% (n = 11) and healing was seen in 42% (n = 5). If indicated, stent removal was performed without any complications. Stent migration (n = 13; 37%) was the most common long-term complication. The placement of self-expanding Polyflex plastic stents is a highly sufficient and cost-effective treatment for malignant and benign esophageal disorders. Because the long-term results were highly favorable, self-expanding plastic stent placement could be used as the initial treatment for various conditions.

Successful Sealing of Benign Esophageal Leaks after Temporary Placement of a Self-Expanding Plastic Stent without Fluoroscopic Guidance

We report on our experience with the temporary use of a self-expanding plastic stent (SEPS) in the treatment of non-malignant esophageal leaks. Between November 2001 and May 2005 ten patients with iatrogenic esophageal perforations (n = 4), post-surgical leaks (n = 5) and esophago-mediastinal fistulas after caustic injury (n = 1) were treated by temporary SEPS placement. In eight out of ten patients SEPS placement was done without fluoroscopy due to the emergency setting. Stent removal was performed with a rat-toothed forceps. Leaks were located in the proximal (n = 1), middle (n = 6) and distal (n = 3) parts of the esophagus. The mean leakage size was 2 cm. Stent placement without fluoroscopy was always successful. The median duration of stent therapy was 55.5 days (range 15,438). In 7/10 cases the SEPS was readily removed, showing complete healing of the former leak. Four patients died during the follow-up. However, their deaths were not related to the stent therapy. The temporary use of the SEPS represents a safe method for sealing benign esophageal leaks. In the emergency-setting SEPS placement without fluoroscopy is feasible and the stent can be easily removed. In contained perforations without severe mediastinitis of the mid esophagus the SEPS should be discussed as a gentle first-line therapy.

Failure of Self-Expanding Plastic Stents in Treatment of Refractory Benign Esophageal Strictures

A removable, self-expanding plastic stent (SEPS) has recently been approved in the United States for management of refractory benign esophageal stricture (RBES), but data on its use are quite limited. Five patients with RBES (two anastomotic, one radiation-induced, one caustic, one peptic) underwent placement of a SEPS at our institution. All five patients developed complications related to SEPS placement. Three patients had distal stent migration, one patient had localized esophageal perforation at the proximal margin of the stent and, following stent placement, one patient developed severe chest pain associated with ulceration at the proximal stent margin. While placement of removable SEPS is a conceptually attractive option for management of RBES, our initial results reveal a high rate of short-term complications. Modifications in stent design may prevent complications and allow adequate time for stricture remodeling.

Evaluation and management of benign esophageal strictures

Patients with progressive or solid food dysphagia should be evaluated for the presence of an esophageal stricture. Barium esophagram and endoscopy can define strictures as benign or malignant. The majority of benign strictures are acid-related. Benign strictures are best managed by esophageal dilation with acid-suppressing medications if a peptic stricture is suspected. If dysphagia recurs, repeat dilation should be performed. There are a variety of interventions for refractory strictures which include injection of intralesional corticosteroids, temporary placement of self-expanding plastic stents and surgery.

Management of Postoperative Esophageal Leaks With the Polyflex Self-Expanding Covered Plastic Stent

Esophageal anastomotic leaks can lead to prolonged hospitalization. In this article we present our experience with the placement of the Polyflex self-expanding plastic stent (Willy Ruesch GMBH, Kernen, Germany) for leak occlusion. Between April 2000 and November 2003, 24 patients were included into this prospective study and underwent Polyflex stent placement for postoperative esophageal anastomotic leaks. The primary operation was esophagectomy in 13 patients, gastrectomy in 7, cardia resection in 2, and other procedures in 2 patients. The median interval between operation and stent placement was 19 days (range, 4 to 65). The effectiveness of leak occlusion was evaluated by water-soluble contrast swallow and the clinical course. In 2 patients stent misplacement produced an enlarged anastomotic dehiscence that necessitated reoperation. Radiologic evaluation was impossible in 4 patients because of their generally restricted condition. Among 18 evaluable patients, leak occlusion was successful with a single stent in 16 patients (89%) based on radiologic evaluation. Immediate oral feeding was well tolerated by these patients. After a median follow-up of 220 days (range, 7 to 1221), 9 cases of late stent dislocation were observed. Stent removal in patients after esophagectomy with gastric pull-up led to dysphagia from anastomotic strictures in 2 patients. Symptomatic strictures did not develop in the 5 evaluable postgastrectomy patients after stent removal. The placement of self-expanding plastic stents is a highly effective treatment for esophageal anastomotic leaks. Because clinically-relevant anastomotic strictures can be expected, we do not recommend stent removal after esophagectomy with gastric pull-up reconstruction.